Kidney Stones

[Extracted from the website of www.emedicinehealth.com]

The kidney acts as a filter for blood, making urine and removing waste products from the body. It also helps regulate electrolyte levels that are important for body function. Urine drains from the kidney into the bladder through a narrow tube called the ureter. When the bladder fills and there is an urge to urinate, the bladder empties through the urethra, a much wider tube than the ureter.

In some people, chemicals crystallize in the urine and form the beginning, or nidus, of a kidney stone. These stones are very tiny when they form, smaller than a grain of sand, but gradually can grow over time to a 1/10 of an inch or larger. Urolithiasis is the term that refers to the presence of stones in the urinary tract, while nephrolithiasis refers to kidney stones. The size of the stone doesn't matter as much as where it is located.

When the stone sits in the kidney, it rarely causes problems, but when it falls into the ureter, it acts like a dam. As the kidney continues to function and make urine, pressure builds up behind the stone and causes the kidney to swell. This pressure is what causes the pain of a kidney stone, but it also helps push the stone along the course of the ureter. When the stone enters the bladder, the obstruction in the ureter is relieved and the symptoms of a kidney stone are resolved.

Causes

There is no consensus as to why kidney stones form.

* Heredity : Some people are more susceptible to forming kidney stones, and heredity may play a role. The majority of kidney stones are made of calcium, and hypercalciuria (high levels of calcium in the urine) is a risk factor. The predisposition to high levels of calcium in the urine may be passed on from generation to generation. Some rare hereditary diseases also predispose some people to form kidney stones. Examples include people with renal tubular acidosis and people with problems metabolizing a variety of chemicals including cystine (an amino acid), oxalate, (a type of salt), and uric acid (as in gout).

* Geographical location : There may be a geographic predisposition to form kidney stones. There are regional "stone belts," with people living in the southern United States, having an increased risk of stone formation. The hot climate and poor fluid intake may cause people to be relatively dehydrated, with their urine becoming more concentrated and allowing chemicals to come in closer contact to form the nidus, or beginning, of a stone.

* Diet : Diet may or may not be an issue. If a person is susceptible to forming stones, then foods high in calcium may increase the risk; however, if a person isn't susceptible to forming stones, diet will not change that risk.

* Medications : People taking diuretics (or "water pills") and those who consume excess calcium-containing antacids can increase the amount of calcium in their urine and potentially increase their risk of forming stones. Taking excess amounts of vitamins A and D are also associated with higher levels of calcium in the urine. Patients with HIV who take the medication indinavir (Crixivan) can form indinavir stones. Other commonly prescribed medications associated with stone formation include dilantin and antibiotics like ceftriaxone (Rocephin) and ciprofloxacin (Cipro).

* Underlying illnesses : Some chronic illnesses are associated with kidney stone formation, including cystic fibrosis, renal tubular acidosis, and inflammatory bowel disease.

Symptoms and Signs

When a tubular structure is blocked in the body, pain is generated in waves as the body tries to unblock the obstruction. These waves of pain are called colic. This is opposed to non-colicky type pain, like appendicitis or pancreatitis, in which movement causes increased pain and affected people hold very still.

* Renal colic (renal is the medical term for things related to the kidney) has a classic presentation when a kidney stone is being passed.

o The pain is intense and comes on suddenly. It may wax and wane, but there is usually a significant underlying ache between the acute spasms of pain.

o It is usually located in the flank or the side of the mid back and radiates to the groin.

o Those affected cannot find a comfortable position, and many writhe in pain.

* Sweating, nausea, and vomiting are common.

* Blood may be visible in the urine because the stone has irritated the ureter. Blood in the urine (hematuria), however, does not always mean a person has a kidney stone. There may be other reasons for the blood, including kidney and bladder infections, trauma, or tumors. Urinalysis with a microscope may detect blood even if it is not appreciated by the naked eye. Sometimes, if the stone causes complete obstruction, no blood may be found in the urine because it cannot get past the stone.

Exams and Tests

The classic presentation of renal colic associated with blood in the urine suggests the diagnosis of kidney stone. Many other conditions can mimic this disease, and the physician or health-care provider may need to order tests to confirm the diagnosis. One example is that pain radiating to the back, may cause the health-care provider to be concerned about the possibility of a leaking abdominal aortic aneurysm.

Physical examination is often not helpful in patients with kidney stones, aside from the finding of flank (side of the body between the ribs and hips) tenderness. The examination is often directed to ensuring that other potentially dangerous conditions are not present. As examples, when examining the abdomen, the physician may look for a palpable mass that pulsates, which may be a sign of an aortic aneurysm. Tenderness under the right rib cage margin may signal gallbladder disease. Tenderness in the lower quadrants may be associated with appendicitis, diverticulitis, or ovarian disease.

Symptom control is very important, and medication for pain and nausea may be provided before the confirmation of the diagnosis occurs.

A urinalysis may detect blood in the urine. It is also done to look for evidence of infection, a complication of kidney stone disease.

Blood tests are usually not indicated, unless the health-care provider has concerns about the diagnosis or is worried about kidney stone complications.

Computerized tomography (CT) scanning of the abdomen without oral or intravenous contrast dye is the most commonly used diagnostic test. The scan will demonstrate the anatomy of the kidneys, ureter, and bladder and can detect a stone, its location, its size, and whether it is causing dilation of the ureter and inflammation of the kidney. The CT can also evaluate many other organs in the abdomen, including the appendix, gallbladder, liver, pancreas, aorta, and bowel. However, since no contrast material is used, there are some limitations to the detail that can be observed in the images of the scan.

Ultrasound is another way of looking for kidney stones and obstruction and may be useful when the radiation risk of a CT scan is unwanted (for example, if a woman is pregnant). Ultrasound requires a specially trained person to obtain the images, and therefore, it may not always be available.

In those patients who already have the diagnosis of a kidney stone, plain abdominal X-rays may be used to track its movement down the ureter toward the bladder.

Medical Treatment

* In the emergency department, intravenous fluids may be provided to help with hydration and to allow the administration of medications to control pain and nausea. Ketorolac (Toradol), an injectable antiinflammatory drug, and narcotics may be used for pain control, with the goal being to relieve suffering and not necessarily to make the patient pain free. Nausea and/or vomiting may be treated with antiemetic medications like ondansetron (Zofran), promethazine (Phenergan), or droperidol (Inapsine).

* The decision to send a patient home will depend upon the response to medication. If the pain is intractable (hard to control) or if vomiting persists, then admission to the hospital is necessary. Also, if an infection is associated with the stone, then admission to the hospital will be considered.

* Pain control at home follows the lead of the hospital treatment. Over-the-counter (OTC) ibuprofen is used as an antiinflammatory medication, and narcotic pain pills may be provided. Anti-nausea medication may be prescribed either by mouth or by suppository. Tamsulosin (Flomax, a drug used to facilitate urination in men with enlargement of the prostate) may be used to help facilitate the passage of stones into the bladder.

* Because of their size or location, some stones may not be able to be passed without help. If the stone is high up in the ureter, near the kidney, and is large, then a urologist may need to consider using lithotripsy, or shock wave therapy (EWSL), to break the stone up into fragments to allow the smaller pieces to pass into the bladder. Shock waves work by vibrating the urine surrounding the stone and causing the stone to break up. Stones that are lodged nearer the bladder do not have surrounding urine to allow this procedure to work successfully.

* If the stone is not located in a place where lithotripsy can work or if there is a need to relieve the obstruction emergently (an example would include the presence of an infection), the urologist may perform ureteroscopy, in which instruments are threaded into the ureter and can allow the physician to place a stent (a thin hollow tube) through the urethra, past the bladder, and into the ureter to bypass the obstructing stone. This stent may be left in place for a longer period of time. Occasionally, the urologist may be able to use instruments to grab the stone and remove it.

Complications

* Since most patients have two kidneys, a temporary obstruction of one is not of great significance. For those patients with only one kidney, an obstructing stone can be a true emergency, and the need to relieve the obstruction becomes greater. A kidney that remains completely obstructed for a prolonged period of time may stop working.

* Infection associated with an obstructing stone is another emergent situation. When urine is infected and cannot drain, it acts like an abscess and can spread the infection throughout the body (sepsis). Fever is a major sign of this complication, but urinalysis may show an infection and cause the urologist to decide to place a stent or remove the stone.

Follow-up

* For the first-time kidney stone patient, there should be an attempt to catch the stone by straining the urine, so that it can be sent for analysis. The stone may be so tiny that it may not be recognized. While most stones are made of calcium oxalate, stones can also consist of other chemicals. It may be possible to prevent future stone formation by taking medications. For those whose stone disease is recurrent and the kind of stone is known, this instruction is often omitted.

* Drinking plenty of water will help push the stone down the ureter to the bladder and hasten its elimination.

* A follow-up visit with a urologist may be arranged one to two weeks after the initial visit, allowing the stone to pass on its own.

* Patients should call their physician or return to the emergency department if the pain medication is not working to control the pain, if there is persistent vomiting, or if a fever occurs.

What is Gastroenteritis, or commonly known as Stomach Flu ?

[Extracted from the website of www.emedicinehealth.com]

Gastroenteritis is a condition that causes irritation and inflammation of the stomach and intestines (the gastrointestinal tract). Diarrhea, crampy abdominal pain, nausea, and vomiting are the most common symptoms.

Viral infection is the most common cause of gastroenteritis but bacteria, parasites, and food-borne illness (such as shellfish) can be the offending agent.

Many people who experience the vomiting and diarrhea that develop from these types of infections or irritations think they have "food poisoning," and they may indeed have a food-borne illness. Many people also refer to gastroenteritis as "stomach flu," although influenza has nothing to do with the condition.

Travelers to foreign countries may experience "traveler's diarrhea" from contaminated food and unclean water.

* The severity of infectious gastroenteritis depends on the immune system's ability to resist the infection. Electrolytes (these include essential elements of sodium and potassium) may be lost as you vomit and experience diarrhea.

* Most people recover easily from a short bout with vomiting and diarrhea by drinking fluids and easing back into a normal diet. But for others, such as infants and the elderly, loss of bodily fluid with gastroenteritis can cause dehydration, which is a life-threatening illness unless the condition is treated and fluids restored.

Causes

Gastroenteritis has many causes. Viruses and bacteria are the most common.

Viruses and bacteria are very contagious and can spread through contaminated food or water. In up to 50% of diarrheal outbreaks, no specific agent is found. Improper handwashing following a bowel movement or handling a diaper can spread the disease from person to person.

Gastroenteritis caused by viruses may last one to two days. On the other hand, bacterial cases can last for a longer period of time.

Viruses

Fifty to seventy percent of cases of gastroenteritis in adults are caused by the noroviruses.

Rotavirus is the leading cause of infection in children.

Other viruses that cause gastrointestinal symptoms include :

* Adenoviruses

* Parvoviruses

* Astroviruses

Bacteria

Bacteria may cause gastroenteritis directly by infecting the walls of the stomach and intestine. As well, some bacteria like Staphylococcus aureus can form a toxin that is the cause of symptoms. Staph is a common type of food poisoning.

Escherichia coli can cause significant problems, and one type of the bacteria, E. coli O157:H7 can also affect kidney function.

Salmonella, Shigella and Campylobacter are also common causes of illness.

* Salmonella - the cause of typhoid fever is contracted from handling poultry or reptiles such as turtles that carry the germs

* Campylobacter - from the consumption of undercooked meat, unpasteurized milk

* Shigella - typically spread from person to person

Clostridium difficile (C difficile) bacteria may overgrow in the large intestine after a patient has been on antibiotics for an infection.

Parasites and protozoans

These tiny organisms are less frequently responsible for intestinal irritation. You may become infected by one of these by drinking contaminated water. Swimming pools are common places to come in contact with these parasites. Common parasites include these:

* Giardia - The most frequent cause of waterborne diarrhea, causing giardiasis

* Cryptosporidium - Affects mostly people with weakened immune systems and causes watery diarrhea

Other common causes

Gastroenteritis that is not contagious to others can be caused by chemical toxins, most often found in seafood, food allergies, heavy metals, antibiotics, and other medications.

Symptoms

By definition, gastroenteritis affects both the stomach and the intestines, resulting in both vomiting and diarrhea.

Common symptoms may include :

* Low grade fever to 100°F (37.7°C)

* Nausea with or without vomiting

* Mild-to-moderate diarrhea:

* Crampy painful abdominal bloating

More serious symptoms

* Blood in vomit or stool

* Vomiting more than 48 hours

* Fever higher than 101°F (40°C)

* Swollen abdomen or abdominal pain

* Dehydration - weakness, lightheadedness, decreased urination, dry skin, dry mouth and lack of sweat and tears are characteristic findings.

What is Vitiligo ?

[Extracted from the website of www.medicinenet.com]

Vitiligo (vit-ill-EYE-go) is a pigmentation disorder in which melanocytes (the cells that make pigment) in the skin are destroyed. As a result, white patches appear on the skin in different parts of the body. Similar patches also appear on both the mucous membranes (tissues that line the inside of the mouth and nose), and the retina (inner layer of the eyeball). The hair that grows on areas affected by vitiligo sometimes turns white.

The cause of vitiligo is not known, but doctors and researchers have several different theories. There is strong evidence that people with vitiligo inherit a group of three genes that make them susceptible to depigmentation. The most widely accepted view is that the depigmentation occurs because vitiligo is an autoimmune disease -- a disease in which a person's immune system reacts against the body's own organs or tissues. As such, people's bodies produce proteins called cytokines that alter their pigment-producing cells and cause these cells to die. Another theory is that melanocytes destroy themselves. Finally, some people have reported that a single event such as sunburn or emotional distress triggered vitiligo; however, these events have not been scientifically proven as causes of vitiligo.

Who is affected by vitiligo ?

About 0.5 to 1 percent of the world's population, or as many as 65 million people, have vitiligo. In the United States, 1 to 2 million people have the disorder. Half the people who have vitiligo develop it before age 20; most develop it before their 40th birthday. The disorder affects both sexes and all races equally; however, it is more noticeable in people with dark skin.

Vitiligo seems to be somewhat more common in people with certain autoimmune diseases. These autoimmune diseases include hyperthyroidism (an overactive thyroid gland), adrenocortical insufficiency (the adrenal gland does not produce enough of the hormone called corticosteroid), alopecia areata (patches of baldness), and pernicious anemia (a low level of red blood cells caused by the failure of the body to absorb vitamin B12). Scientists do not know the reason for the association between vitiligo and these autoimmune diseases. However, most people with vitiligo have no other autoimmune disease.

Vitiligo may also be hereditary; that is, it can run in families. Children whose parents have the disorder are more likely to develop vitiligo. In fact, 30 percent of people with vitiligo have a family member with the disease. However, only 5 to 7 percent of children will get vitiligo even if a parent has it, and most people with vitiligo do not have a family history of the disorder.

What are the symptoms vitiligo ?

People who develop vitiligo usually first notice white patches (depigmentation) on their skin. These patches are more commonly found on sun-exposed areas of the body, including the hands, feet, arms, face, and lips. Other common areas for white patches to appear are the armpits and groin, and around the mouth, eyes, nostrils, navel, genitals, and rectum.

In addition to white patches on the skin, people with vitiligo may have premature graying of the scalp hair, eyelashes, eyebrows, and beard. People with dark skin may notice a loss of color inside their mouths.



Will the depigmented patches spread ?

Focal pattern vitiligo and segmental vitiligo remain localized to one part of the body and do not spread. There is no way to predict if generalized vitiligo will spread. For some people, the depigmented patches do not spread. The disorder is usually progressive, however, and over time the white patches will spread to other areas of the body. For some people, vitiligo spreads slowly, over many years. For other people, spreading occurs rapidly. Some people have reported additional depigmentation following periods of physical or emotional stress.

How is vitiligo diagnosed ?

The diagnosis of vitiligo is made based on a physical examination, medical history, and laboratory tests.

A doctor will likely suspect vitiligo if you report (or the physical examination reveals) white patches of skin on the body-particularly on sun-exposed areas, including the hands, feet, arms, face, and lips. If vitiligo is suspected, the doctor will ask about your medical history. Important factors in the diagnosis include a family history of vitiligo; a rash, sunburn, or other skin trauma at the site of vitiligo 2 to 3 months before depigmentation started; stress or physical illness; and premature (before age 35) graying of the hair. In addition, the doctor will ask whether you or anyone in your family has had any autoimmune diseases, and whether you are very sensitive to the sun.

To help confirm the diagnosis, the doctor may take a small sample (biopsy) of the affected skin to examine under a microscope. In vitiligo, the skin sample will usually show a complete absence of pigment-producing melanocytes. On the other hand, the presence of inflamed cells in the sample may suggest that another condition is responsible for the loss of pigmentation.

Because vitiligo may be associated with pernicious anemia (a condition in which an insufficient amount of vitamin B12 is absorbed from the gastrointestinal tract) or hyperthyroidism (an overactive thyroid gland), the doctor may also take a blood sample to check the blood-cell count and thyroid function. For some patients, the doctor may recommend an eye examination to check for uveitis (inflammation of part of the eye), which sometimes occurs with vitiligo. A blood test to look for the presence of antinuclear antibodies (a type of autoantibody) may also be done. This test helps determine if the patient has another autoimmune disease.

How can people cope with the emotional and psychological aspects of vitiligo ?

While vitiligo is usually not harmful medically, its emotional and psychological effects can be devastating. In fact, in India, women with the disease are sometimes discriminated against in marriage. Developing vitiligo after marriage can be grounds for divorce.

Regardless of a person's race and culture, white patches of vitiligo can affect emotional and psychological well-being and self-esteem. People with vitiligo can experience emotional stress, particularly if the condition develops on visible areas of the body, such as the face, hands, arms, and feet; or on the genitals. Adolescents, who are often particularly concerned about their appearance, can be devastated by widespread vitiligo. Some people who have vitiligo feel embarrassed, ashamed, depressed, or worried about how others will react.

Fortunately, there are several strategies to help people cope with vitiligo. Also, various treatments-which we will discuss a bit later-can minimize, camouflage, or, in some cases, even eliminate white patches. First, it is important to find a doctor who is knowledgeable about the disorder and takes it seriously. The doctor should also be a good listener and be able to provide emotional support. You must let your doctor know if you are feeling depressed, because doctors and other mental health professionals can help people deal with depression. You should also learn as much as possible about the disorder and treatment choices so that you can participate in making important decisions about medical care.

Talking with other people who have vitiligo may also help. The National Vitiligo Foundation can provide information about vitiligo and refer you to local chapters that have support groups of patients, families, and physicians. Contact information for the foundation is listed at the end of this brochure. Family and friends are another source of support.

Some people with vitiligo have found that cosmetics that cover the white patches improve their appearance and help them feel better about themselves. You may need to experiment with several brands of concealing cosmetics before finding the product that works best.

What treatment options are available ?

The main goal of treating vitiligo is to improve appearance. Therapy for vitiligo takes a long time-it usually must be continued for 6 to 18 months. The choice of therapy depends on the number of white patches; their location, sizes, and how widespread they are; and what you prefer in terms of treatment. Each patient responds differently to therapy, and a particular treatment may not work for everyone. Current treatment options for vitiligo include medical, surgical, and adjunctive therapies (therapies that can be used along with surgical or medical treatments).

What is Angina ?

[Extracted from the website of the University of Maryland Medical Center]

Angina is chest pain caused by restricted blood flow to the heart (called ischemia). It usually occurs when you are under emotional or physical stress (such as exercise). The heart doesn't get enough oxygen from the coronary arteries, and you feel a squeezing chest pain or pressure across your chest, which usually goes away after you stop the activity. The most common cause of angina is atherosclerosis (hardening of the arteries).

Stable angina usually occurs when you exercise and is fairly predictable. It is relieved with rest or nitroglycerin. Unstable angina, on the other hand, can occur when you are resting, or at unpredictable times. It can lead to a heart attack, so if you experience unstable angina you should immediately call 911.

It can be difficult to determine whether your chest pain is something serious or whether it is a milder condition. For that reason, you should always see your doctor for a diagnosis and treatment. Angina can lead to a heart attack, so you should never try to diagnose or treat it on your own.

Signs and Symptoms :

Chest pain from angina can feel like pain due to other causes such as heartburn, a muscle strain, or asthma. When in doubt, assume that the pain is related to your heart until proven otherwise, especially if you are experiencing pain that you have never felt before.

The classic chest pain from angina feels like significant pressure, squeezing, or tightness in the center of your chest. It has been described as feeling like a band across the chest or a weight pressing down on the chest. You may also feel pain in your left arm and shoulder, neck, and jaw. Other possible feelings include indigestion, rapid or skipping heartbeat, or mild discomfort.



Causes :

Coronary heart disease, which occurs when the arteries leading to the heart become narrowed or blocked by plaque, is almost always the cause of angina.

Risk Factors :

The risk factors for angina are the same as the risk factors for developing heart disease, including :

* Age
* Male gender
* Menopause
* Family history of heart disease
* Diabetes
* Smoking or exposure to second hand smoke
* High cholesterol
* High blood pressure
* Obesity
* Sedentary lifestyle
* Stress
* Thyroid disease

See articles on Atherosclerosis and Heart Attack for more information about risk factors.

Diagnosis :

Your doctor may run several tests to determine the cause of your chest pain.

Electrocardiogram (ECG), which records heart activity through electrodes fastened to your chest.

Stress test, which measures how your heart performs when you exert yourself. You will be hooked up to an ECG machine and may be asked to exercise (usually on a treadmill or stationary bike), or you may be given a drug that causes your heart to act as it does when you exercise. The stress test also may be done with imaging (like thallium, sestimibi, or an echocardiogram) to look at the blood flow and muscle function of your heart.

Coronary catheterization, which examines arteries to see if they are narrowed or blocked, involves injecting a dye into your arteries through a thin catheter.

Other tests may include an electron beam computed tomography (EBCT) scan or cardiovascular magnetic resonance imaging (MRI).

Preventive Care :

If you will be doing an activity that usually triggers your angina, your doctor may tell you to take nitroglycerin a few minutes in advance to prevent the pain.

The best prevention for angina is to modify as many risk factors for heart disease as possible :

* Stop smoking
* Maintain a proper weight
* Control blood pressure, diabetes, and cholesterol
* Eat a diet low in saturated fats, and high in whole grains, fiber, fruits, and vegetables
* Exercise at least 30 minutes per day, 5 days per week
* Reduce stress

Treatment Approach :

In treating angina, your doctor will treat the underlying heart disease to prevent it from getting worse. By doing this, blood flow to the heart improves and angina gets better. Lifestyle changes and certain medications can improve blood flow and make you feel better fairly quickly. Keep track of what causes your angina pain, what it feels like, how often you get it, and how long it lasts. If there's a change in your pattern for the worse (for example, if it happens more frequently or with less exertion), let your doctor know right away.

Lifestyle

Changing your diet, exercising regularly, and practicing relaxation techniques to reduce your response to stress can help improve blood flow to your heart and reduce angina. These steps can also help treat your risk factors for heart disease.

Diet

A diet low in saturated fat and high in whole grains, fruits, and vegetables will help your heart and also keep your weight under control. The American Heart Association recommends that you do the following to prevent or treat heart disease :

* Eat a variety of nutritious foods from all the food groups, especially whole grains, fruits and vegetables, and low fat dairy products.
* Eat at least 2 servings of fish per week
* Limit sodium intake to 2,300 mg per day.
* Limit alcohol intake to 2 drinks per day for men and 1 drink per day for women.
* Burn as many calories as you take in. Get at least 30 minutes of exercise most days (or, better still, every day).

Relaxation

Relaxation techniques may help you reduce stress, which can be a contributing factor to heart disease, and relieve chest pain. Such practices might include the use of meditation, progressive muscle relaxation, breathing exercises, yoga, self hypnosis, or biofeedback.
Medications

For the treatment of stable angina, your doctor will likely recommend daily aspirin as well as a combination of the following prescription medications :

* Nitroglycerin and oral nitrates -- temporarily dilates coronary arteries, allowing the heart to get more blood and oxygen
* Beta-blockers -- slow heart rate and blood pressure, reducing the heart's need for oxygen. You should never abruptly stop taking a beta-blocker, because serious side effects can occur. Talk to your doctor about how to slowly wean off of this drug. Beta-blockers include :

o Atenolol (Tenormin)
o Metoprolol (Lopressor, Toprol-XL)
o Propranolol (Inderal, Inderal LA)

* Calcium-channel blockers -- slow heart rate and cause arteries to dilate.

Calcium-channel blockers include :

o Nifedipine (Procardia)
o Amlodipine (Norvasc)
o Diltiazem (Cardizem)

* Cholesterol lowering medications, such as statins
* Ranolazine (Ranexa) -- used only when other anti angina drugs don't work, due to potential side effects. It is used with other anti-angina medications, such as beta-blockers or nitroglycerin.



Surgery and Other Procedures

If lifestyle changes and medications are not effective or if unstable angina develops, you may need coronary artery bypass graft surgery, angioplasty with stent placement, or another type of procedure to improve blood flow to your heart.

Nutrition and Dietary Supplements

Eat a well balanced diet with plenty of whole grains, fruits, vegetables, and low fat dairy products. If approved by your physician, make sure you exercise at least 30 minutes a day most days of the week.

There are many supplements that can help reduce your chances of developing heart disease and its consequences, including angina.

A few supplements are being studied specifically to reduce the pain from angina. However, you should never try to treat angina on your own, and should only take supplements or herbs under your doctor's supervision. The doses given below are ones that have been used in studies; it is important to talk to your doctor about what dose might be best for you.

* L-carnitine (1 g 2 times per day), an amino acid, may help reduce symptoms of angina, according to several clinical trials.

* Coenzyme Q10 or CoQ10 (150 mg per day) is important for heart health and several studies suggest that taking it may allow people with angina to exercise more without pain. High doses of CoQ10 may interfere with some anticoagulants (blood thinners), so talk to your doctor before taking CoQ10 if you take anticoagulants.

* Arginine or l-arginine (2 g 3 times per day) is another amino acid that may improve blood flow and increase exercise tolerance in people with angina.

* Magnesium (365 mg 2 times per day) acts similar to a calcium-channel blocker in the body, although it is much weaker. One study suggested it may help reduce chest pain caused by exercise. Magnesium can lower blood pressure and cause diarrhea, so talk to your doctor before taking it.

Herbs

The use of herbs is a time honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care practitioner. If you have angina, do not take any herbs without your doctor's supervision.

There are several different herbs that may be helpful for the treatment and prevention of heart disease, including those that help you reduce your cholesterol, blood pressure, and other risk factors. See articles on Atherosclerosis, Heart attack, High blood pressure, and High cholesterol for more information. Herbs that may be helpful for angina include :

* Hawthorn (Crataegus monogyna, 60 mg 3 times per day) has been used traditionally as a to treat heart disease. One small clinical trial suggested that people with angina who took hawthorn improved blood flow to the heart and were better able to exercise without pain. However, the trial was small and more studies are needed. Hawthorn can cause side effects and interact with other drugs, so do not take it without your doctor's supervision.

* Kudzu (Pueria lobota, 30 mg - 120 mg per day) has been used in Chinese medicine for centuries to treat heart disease. A few clinical trials have indicated that kudzu may reduce the frequency of angina in people, but the trials were poorly designed. More research is needed. Kudzu can cause side effects and interact with other drugs, so do not take it without your doctor's supervision.

* Terminalia arjuna, an herb used in Ayurvedic medicine, was shown in one study to be as effective as isosorbide mononitrate (Imdur) in reducing the number of angina attacks and increasing exercise capacity. However, more studies are needed.

* Suxiao jiuxin wan is widely used in China for angina. One study found that suxiao jiuxin wan improved ECG measurements and reduced symptoms and frequency of acute angina attacks compared with nitroglycerin.

Homeopathy

Homeopathy should never be used instead of immediate medical attention for unstable angina, new onset chest pain, or chest pain that has changed in intensity, frequency, or other characteristics. Homeopathy may, however, be used to help reduce your risk of heart disease, along with other medications. Although few studies have examined the effectiveness of specific homeopathic remedies, professional homeopaths would recommend appropriate therapy to lower high blood pressure and cholesterol. Before prescribing a remedy, homeopaths take into account your constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath would assess all of these factors when determining the most appropriate remedy for you as an individual.

Acupuncture

Studies using acupuncture to treat angina have found mixed results. While some show no benefit, others have found that acupuncture may help reduce the frequency of angina attacks and the need to use nitroglycerin.

Prognosis and Complications

Stable angina can progress and become unstable and even lead to a heart attack. The good news, however, is that with the right treatment including eating proper diet, getting enough exercise, and taking medication, blood flow to the heart can dramatically improve, lessening the likelihood of angina attacks.